Unknown Individual – Physical Therapist, NPI 1073045910

Unknown Individual is a healthcare provider. based in Ooltewah, Tennessee. specializing in Physical Therapist. The NPI Number for Unknown Individual is 1073045910

Main info

Organization
Inactive
10 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073045910
Phone
(423) 238-7217
Address
8823 PRODUCTION LN
Deactivation Date
4 February 2022

Doctor Profile

Medical School Name
EAST TENNESSEE STATE UNIVERSITY QUILLEN COLLEGE OF MEDICINE
Secondary Phone
9314245588
Graduation Year
2016 (10 years ago)
PAC ID
4981952736
Group Practice PAC ID
9335056308
Professional Enrollment ID
I20180809006273
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 8823 PRODUCTION LN

    OOLTEWAH, TN 373636511

    Phone: (423) 238-7217

    Fax: (423) 362-8684

    Type: Mailing

  • 203 VILLAGE SQ

    PULASKI, TN 384782929

    Phone: (931) 424-5588

    Fax: (931) 424-5590

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 37363)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9335056308View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1073045910.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Physical Therapist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Ooltewah, Tennessee in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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